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Results for “Personal Autonomy”

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PubMed2005

Correlates of perceived autonomy among elders in a senior citizen home: a cross-sectional survey.

BACKGROUND: Researchers have pointed out several factors that correlated with or influenced autonomy in older people. However, these studies covered only a range of socio-demographic or physical factors, while factors from psychosociological and spiritual domains remain ignored. Also, there is lack of quantitative research and publications in this area. OBJECTIVES: To explore factors related to autonomy among elders in a senior citizen home. DESIGN: A cross-sectional design utilizing a correlational approach was adopted. PARTICIPANTS: A stratified random sample of 121 subjects older than 64 years was recruited at a senior citizen home. METHODS: Questionnaires and interviews were used to collect data. The structured questionnaire consisted of five parts, each gauging socio-demographic information, life attitudes, frequency and satisfaction of social support, and autonomy. Descriptive and stepwise multiple linear regression analysis were used to analyze the data. FINDINGS: Subjects had a high autonomy score (mean = 3.63), with the greatest score in independence (mean = 4.39), followed by individuality (mean = 3.74) and freedom (mean = 3.22). Multiple regression analysis showed that satisfaction of social support (beta = .57), functional ability (beta = .25), life attitudes (beta = .20), and level of education (beta = .14) significantly affected autonomy in these elderly subjects and explained 64.2% of the total variance of autonomy in this population. CONCLUSIONS: Findings from this study indicate that perceived autonomy is influenced by social support, functional ability, life attitude, and literacy among institutionalized elders.

Activities of Daily Living↗

PubMed2005

Unaccompanied adolescents seeking asylum: poorer mental health under a restrictive reception.

We assessed the effects of a stringent reception policy on the mental health of unaccompanied adolescent asylum seekers by comparing the mental health of adolescents in a restricted campus reception setting and in a setting offering more autonomy (numbers [response rates]: 69 [93%] and 53 [69%], respectively; mean age, 16 years). Unaccompanied adolescent asylum seekers in a restricted reception setting reported more emotional problems on the Hopkins Symptom Checklist than their counterparts in the more autonomy group (mean scores [SD]: restricted, 59.3 [13.1]; other, 53.4 [10.5]; p = 0.033, F test). Main effects concerned a rise in anxiety. Girls showed larger differences than boys. A restrictive reception may therefore affect the mental health of minor asylum seekers. Health care workers and policy makers should be aware of this adverse effect.

Adolescent↗

PubMed2001

Assessing risk and harm: the convergence of ethical and empirical considerations.

Neurorehabilitation clinicians are frequently asked to make clinical predictions of risk and harm in cases where persons with brain injury are believed to be unable or unsafe to conduct normal activities of daily living. Because predictions of risk and harm may ultimately limit a brain-injured person's autonomy, clinical decision makers should be aware of the ethical and empirical issues involved in such determinations. Constraining autonomy can be an ethical problem even when clinicians are apparently acting in patients' best interests. Clinicians must consider their ability to make accurate risk and harm predictions based on clinical data. Clinicians who are aware of contemporary ethical principles will be most prepared to integrate ethical and empirical considerations when determining risk and harm.

Activities of Daily Living↗

PubMedDate not supplied

[Interdependencies between the ideal self-image and the ideal image of parents in women with anorexia nervosa].

AIM: The aim of this work was to answer the following question: in the perception of patients, what kind of dependencies occur between ideal images of women with anorexia and ideal images of their mothers and fathers. TEST GROUP AND METHOD: The examined group consisted of 30 patients diagnosed with anorexia nervosa, undergoing treatment at the Department of Psychiatry of the Medical University in Lublin. The average age of the examined females was 21 years. The ideal images were examined with the Gough and Heilbrun Adjective Check List (ACL), which was completed by the patients three times following the instruction: "I would like to be", "I would like my mother to be", "I would like my father to be". RESULTS: 24 statistically significant correlations were obtained between ideal images of the patients and their mothers, whereas between the ideal images of the patients and their fathers the number of positive significant correlations was 21. CONCLUSIONS: 1. Dependencies were found between ideal images of the patients and their mothers as regards nurturance, intraception, affiliation, exhibition, dominance, autonomy, abasement and heterosexuality, self-discipline, self-control, ambition, diligence and self-confidence. 2. Dependencies were found between ideal images of the patients and their fathers as regards achievement, dominance, intraception, nurturance, affiliation, autonomy, aggression, exhibition and heterosexuality, self-control, ambition, resoluteness, self-confidence as well as such characteristics as: protectiveness, spontaneity and responsibility. 3. The following dependencies occur between ideal images of mothers and ideal images of fathers as perceived by women with anorexia: need for dominance, exhibition, heterosexuality and nurturance, deference and ambition.

Adult↗

PubMed2003

Perceived enactment of autonomy and related factors among elders.

This study aims to investigate the perceived enactment of autonomy (PEA) of Chinese elders as well as its relationship to other variables, such as morale, life satisfaction, need for assistance, subjective overall health status, etc. Selected demographic attributes (gender, age, living arrangements, etc.) were also examined for their relationship to PEA. A purposive sample of 324 subjects over 64 years old was recruited from homes and long-term care facilities in southern Taiwan. A Chinese version of the PEA scale (PEA-CV) and the Revised Philadelphia Geriatric Center Morale Scale (R-PGCMS) were used to measure PEA and morale. Data were analyzed using SPSS/PC software version 10.0. The results show that these elders had high perceived enactment of autonomy (mean = 2.99). Through multiple regression analysis, these results also revealed that need for daily living assistance, type of living arrangement, scores for morale and marital status significantly affected perceived enactment of autonomy among Chinese elders. The results suggest that we should help elders recognize possible choices, respect the choices they have made, advocate elders' autonomy while providing assistance, and design appropriate activities for them so that they gain a sense of freedom, individuality and independence. Directions for future studies are suggested.

Activities of Daily Living↗

PubMed2005

The process of attachment and autonomy in latency: a longitudinal study of ten children.

The findings in this clinical, longitudinal study describe the process of attachment and autonomy as it unfolds during the latency period of development. Ten normal boys and girls were studied from ages six through eleven. A separate timetable of latency development for boys and girls is suggested. The differences in the boys' and girls' separation responses, which include feelings of a lack of self-coherence, loss, anger, neediness, movement toward peers and defense functioning, are delineated and discussed.

Child↗

PubMed2005

Ethical reasoning and mental health services with deaf clients.

Ethical problems encountered by mental health practitioners working with deaf clients are often complex and involve issues not fully addressed in professional codes of ethics. A principles-based ethical reasoning process can assist in resolving many of these ethical concerns. Principles such as beneficence, nonmaleficence, autonomy, fairness, integrity, and respect are found in the ethical codes of many disciplines; these can also create a common language or reference point when professionals from different fields attempt to deal with shared problems. This article discusses some applications of these principles in working with deaf individuals and proposes an ethical decision-making process that can provide a framework for ethical reasoning in thinking through complex problems.

Clinical Competence↗

PubMed2006

Leaving home or still in the nest? Parent-child relationships and psychological health as predictors of different leaving home patterns.

In this study, the author examines the patterns of leaving home in a sample of 93 participants and their parents. The quality of parent-child relationships, psychological symptomatology in adolescence and young adulthood, and attachment representation were assessed longitudinally from mid-adolescence to young adulthood. Attachment representation, adolescent autonomy, and parent-adolescent conflict were found to be important predictors of the timing of leaving home. In-time leavers were more securely attached and had been granted high autonomy during adolescence, compared with participants who had left home later or had returned to reside in the family home. Young adults with nonnormative leaving home patterns also showed higher percentages of insecure attachment representations and lower percentages of involvement with a romantic partner. Participants residing with their parents were, according to their parents' perceptions, less psychologically healthy.

Adaptation, Psychological↗

PubMed1999

Autonomy and competency--self-determination in the lives of adults with developmental disabilities.

The principle of autonomy anchors decision making for most North Americans. For people with disabilities, however, the quest for self-determination is often countered by society's responsibility to take care of those who have some area of weakness or incompetence. Those who serve this population must, therefore, intentionally shift the balance of power to encourage independent living and to give people with disabilities a voice in their own lives. Changes in the system of care, training, and the way questions of competency are adjudicated are contemplated.

Activities of Daily Living↗

PubMedDate not supplied

Autonomy, privacy and informed consent 1: concepts and definitions.

This article is the first in a four-part series that explores the concepts of patient autonomy, privacy and informed consent in the context of the provision of nursing care. In this first article an overview of the concepts is provided, and some of the difficulties with definitions of these concepts are considered. The dearth of empirical exploration of the operationalization of the concepts of patient autonomy, privacy and informed consent within nursing practice is highlighted. The second, third and fourth articles report a series of empirical studies carried out with patients and staff in postnatal care, in continuing care of elderly people and in acute surgical care within Scottish NHS settings. These studies are part of a concerted effort to address the lack of empirical investigation of the ethical dimension of nursing care provision and clinical nursing practice.

Humans↗

PubMed2006

School-related risk factors for drunkenness among adolescents: risk factors differ between socio-economic groups.

PURPOSE: To examine, separately for boys and girls, whether socio-economic differences in drunkenness exist in adolescence, whether the level of exposure to school-related risk factors differ between socio-economic groups, and whether the relative contribution of school-related risk factors to drunkenness differ between socio-economic groups. METHODS: The study population was a random sample of 1453 Danish 15-year-old students. The outcome measure was drunkenness 10 times or more, as a lifetime measure. Predictor variables comprised five aspects of well-being at school. Socio-economic position (SEP) was measured by parental occupation. RESULTS: Among girls, exposures to school-related risk factors were more prevalent in lower socio-economic groups. Poor school satisfaction was associated with drunkenness among girls from high SEP, odds ratio (OR) = 2.98 (0.73-12.16). Among boys from high SEP autonomy in decision-making was associated with drunkenness, OR = 2.74 (1.06-7.08), whereas poor school satisfaction was associated with drunkenness among boys from intermediate SEP, OR = 2.26 (0.98-5.22). Weak Parental Support in school-related matters, OR = 3.92 (1.16-13.24), and disliking school, OR = 9.12 (1.77-47.09), were associated with drunkenness among boys from low SEP. These associations were also seen among girls although not significant. CONCLUSION: We found that well-being at school had socially differential impact on drunkenness in adolescence.

Adaptation, Psychological↗

PubMed2005

Do patients with schizophrenia wish to be involved in decisions about their medical treatment?

OBJECTIVE: Little is known about the desire of patients with schizophrenia to be involved in medical decisions affecting their treatment. METHOD: The authors administered the Autonomy Preference Index to 122 inpatients with schizophrenia. In addition, the patients filled out the Drug Attitude Inventory. Sociodemographic data and Positive and Negative Syndrome Scale ratings were available for all patients. RESULTS: The patients expressed a desire for shared decision making that was slightly greater than that of primary care patients. Negative attitudes toward medical treatment and younger age were associated with a higher desire for participation. CONCLUSIONS: It is important to meet the participation needs of patients who are dissatisfied with their psychiatric treatment.

Adult↗

PubMed2004

Informed consent: not just for procedures anymore.

The ethical and legal requirement to obtain informed consent prior to performing a procedure or administering a treatment derives from the concept of personal (patient) autonomy. The competent patient, after receiving appropriate disclosure of the material risks of the procedure or treatment, understanding those risks, the benefits, and the alternative approaches, makes a voluntary and uncoerced informed decision to proceed. This article will present a general overview of the modern concept of informed consent as a process (mutual communication) rather than an event (document signing). The historical evolution of this concept and the legal rulings that have shaped the requirements of informed consent will be cited. The benefits of informed decision making as a communication and risk management tool are presented. This review is intended as general information, and not as legal advice, which should be sought from a health-care attorney.

Communication↗

PubMed2003

On the investigation of primed and chronic autonomous and heteronomous motivational orientations.

Four studies examined primed and chronic autonomous and heteronomous motivations. Study 1 showed that autonomy and heteronomy can be primed and influence perceptions and behavior in a way consistent with consciously regulated motives. In Study 2, a measure of chronic motivation was developed and its construct validity and reliability were assessed. In Study 3, the chronicity measure predicted behavior while consciously regulated motives predicted intention but not behavior. Results of Study 4 replicated results of the priming manipulation in Study 1. However, this effect was moderated by level of motivational chronicity. The priming effect was found to be stronger for non-chronics than for chronics. Overall, the findings suggest that autonomous and heteronomous motivations can be regulated automatically as well as consciously.

Achievement↗

PubMed2006

A social-interactional model of the development of depressive symptoms in adolescence.

This study used longitudinal, multimethod data to examine specific patterns of behavioral interaction with parents and peers that were hypothesized to predict increasing levels of depressive symptoms in early adolescence. Adolescents' struggles in establishing autonomy and relatedness in interactions with mothers, and a withdrawn, angry, or dependent pattern of behavior with a best friend, were assessed with observational and peer-report methods in a community sample of 143 adolescents, who were also assessed for levels of depressive symptoms at age 13 and with whom the authors followed up 1 year later. Study hypotheses were confirmed, with dysfunctional interaction patterns with parents and peers combining additively to account for substantial change variance in depressive symptoms over time. Results are interpreted as highlighting specific behavioral patterns that may be promising to address via psychosocial interventions targeting adolescent depression.

Adolescent↗

PubMed2002

Relationships among perceived enactment of autonomy, self-care, and holistic health in community-dwelling older adults.

The purpose of this article is to report findings from two studies of community-dwelling older adults. The focus of both studies was on delineating relationships among perceived enactment of autonomy (PEA) and selected self-care and health variables from the perspective of Modeling and Role-Modeling nursing theory. Results indicated that PEA, representing the potential for self-care action, was positively correlated to perceived control and morale in Study 1 and to life satisfaction in Study 2. Significant differences in PEA scores were found based on the health indicators of participation in social activities and reliance on others for shopping in Study 2. In addition, Study 1 found that morale, gender, age, perceived control, and education accounted for 39% of the variance in PEA. Implications are discussed for designing theory-based holistic nursing interventions to support PEA in older adults and to direct future research.

Aged↗

PubMed2003

A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19).

Quality of life is the subject of much research. However it lacks an agreed theoretical basis. In studies with older populations(ill) health has been used as a proxy measure for quality of life (QoL). We have developed a needs satisfaction measure of QoL in early old age. Our measure has four ontologically grounded domains: conal, autonomy, pleasure, and self-realization. The measure was piloted with focus groups, a self-completion pilot, and cognitive interview testing. This produced a 22-item scale that was included in a postal questionnaire and sent to 286 people aged 65-75 years.A 92% response rate was achieved. The scale was reduced to 19 items on the basis of statistical analysis. The domains have Cronbach's alphas between 0.6 and 0.8. Correlations between the four domains range from 0.4 to 0.7. A second order factor analysis revealed a single latent QoL factor. The scores for the 19-item scale are well distributed along the range although they exhibit a slight negative skew. Concurrent validity was assessed using the Life Satisfaction Index--wellbeing. A strong and positive association was found between the two scales (r= 0.6, p = 0.01). The CASP-19 appears to be a useful scale for measuring QoL in older people.

Aged↗

PubMed2001

Enhanced self-determination of adults with intellectual disability as an outcome of moving to community-based work or living environments.

In recent years, the self-determination construct has received increased international visibility and utilization in the field of intellectual disability (ID). This has resulted in efforts to promote skills enhancing self-determination, and in efforts to change how adult services are funded to allocate resources to increase consumer control and direction. An important component to consider in both of these efforts is the role of the environment on self-determination. The present study examined the self-determination, autonomy and life choices of individuals with ID before and after they moved from a more restrictive work or living environment. The self-determination of adults with ID was measured for an average 6-months before and after a move from a more restrictive living or working environment to a community-based setting. Paired-sample t-tests indicated that there were significant changes, in each case in a more adaptive direction, in self-determination, autonomous functioning and life choices following a move to a less restrictive environment. The present findings contribute to emerging evidence that the self-determination of individuals with ID is limited by congregate living or work settings which limit opportunities for choice and decision-making. Alternatively, more normalized, community-based environments support and enhance self-determination. Because self-determination has been linked to positive adult outcomes and enhanced quality of life, it is important to consider ways to enable people with ID to live and work in their communities.

Activities of Daily Living↗